ED Pathway for Evaluation/Treatment of Children with Sexual Abuse Concerns

Complete History

Documentation – Use quotation marks for patients statements

See Documentation

History / Interview

Interview Team: Social Worker, ED MD/CRNP
  +/- SART RN, Law Enforcement
Team should designate Interview Leader
(non-leader team member should hold questions until the end of the interview)
Child HPI Teen HPI
Interview parent / guardian alone Interview patient alone
Interview child alone Discuss confidentiality
Use open-ended questions SHAADS
Identify patient's "body part" language.

All Patients

What?

  • Date, time, location, use of threats, force, restraint
  • Memory loss, LOC, drugs, alcohol
  • Contact – oral, vaginal, rectal, ejaculation, condom use
  • Bleeding, pain, any other trauma
  • After the event: bathed, changed clothing, ate, mouthwash, barrier contraceptive device

Who?

  • Perpetrator identification, age relationship
  • Current location

When?

  • Beginning, last contact, last possible contact

Where?

  • Location
  • What has been done for this episode?

ROS

 

Genital Complaints

  • Vaginal irritation, bleeding, discharge
  • Dysuria, urinary frequency, enuresis
  • Rectal pain, bleeding

Behavioral problems

  • Recent “acting out”, hyperactivity, withdrawn
  • Sexually explicit behavior inappropriate for age
  • Nightmares or recent change in sleeping habits

Last void, last stool

 

Past Medical History

Menstrual History

  • Menarche, LMP

Sexual History

  • STI, pregnancy, birth control, names of all consensual sex partners within last month
  • Recent antibiotics
  • Name of any individual that the patient has had any sexual relationships with during the past 96 hours.

Immunization

  • Hepatitis B

Previous Police or Social Services report?